Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy
Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy
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DOI：
10.1016/j.jamcollsurg.2006.12.032
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发表时间：
2007-05-01
影响因子：
5.2
通讯作者：
Vauthey, Jean-Nicolas
中科院分区：
文献类型：
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作者：
Mullen, John T.;Ribero, Dario;Vauthey, Jean-Nicolas
背景：建立非肝硬化大肝切除术患者术后肝功能不全（PHI）的可靠定义。尚未建立PHI的标准定义，但对于跨研究结果数据的有意义比较至关重要。方法：对1995年至2005年在3个中心接受大肝切除术（3个或更多肝段）的1,059名非肝硬化患者的数据进行分析。采用术后胆红素峰值（peak）Bil)和国际标准化比值（PeakINR）的受试者工作特征（ROC）分析来定义PHI。结果：669例（63%）患者行3 ~ 4肝段切除术；390例（37%）切除了5个或更多节段。453例（43%）出现并发症。90天的全因死亡率为4.7%，比30天的死亡率（3.2%）高出47%。20例（1.9%）患者死于与肝脏无关的原因。在剩余的1039例患者中，30例（2.8%）在中位36天内死于肝脏相关原因（肝功能衰竭伴或不伴多器官衰竭）。ROC分析显示，预测肝脏相关死亡的临界值为（峰值）Bil 7.0 mg/dL（曲线下面积0.982，灵敏度93.3%，特异性94.3%）和PeakINR 2.0（曲线下面积0.846，灵敏度76.7%，特异性82.0%）。（峰值）Bil bb0 7.0 mg/dL是任何（优势比[OR] = 83.3）或主要并发症（OR = 10.0）、90天死亡率（OR = 10.8）和90天肝脏相关死亡率（OR = 250）的最有效预测因子（均p < 0.0001）。结论：PHI定义为（峰值）Bil > 7.0 mg/dL可准确预测肝切除术后肝脏相关死亡和更差的预后。并发症、PHI和90天死亡率的标准化报告对于准确确定主要肝切除术的风险和比较结果数据至关重要。
BACKGROUND: To establish a reliable definition of postoperative hepatic insufficiency (PHI) in noncirrhotic patients undergoing major hepatectomy. No standard definition of PHI has been established, but one is essential for meaningful comparison of outcomes data across studies.METHODS: Data from 1,059 noncirrhotic patients who underwent major hepatectomy (3 or more liver segments) at 3 centers from 1995 to 2005 were analyzed. Receiver operating characteristics (ROC) analysis of peak postoperative bilirubin ((Peak)Bil) and international normalized ratio (PeakINR) were used to define PHI.RESULTS: A total of 669 patients (63%) underwent resection of 3 to 4 liver segments; 390 (37%) underwent resection of 5 or more segments. Complications occurred in 453 (43%). The 90-day all-cause mortality rate was 4.7%, which is 47% higher than the 30-day rate (3.2%). Twenty (1.9%) patients died of causes unrelated to the liver. Of the remaining 1,039 patients, 30 (2.8%) died a median 36 days from liver-related causes (liver failure with or without multiorgan failure). ROC analysis revealed cut-offs that predict liver-related death are (Peak)Bil 7.0 mg/dL (area under the curve 0.982; sensitivity 93.3%; specificity 94.3%) and PeakINR 2.0 (area under the curve 0.846; sensitivity 76.7%; specificity 82.0%). (Peak)Bil > 7.0 mg/dL was the most powerful predictor of any (odds ratio [OR] = 83.3) or major complication (OR = 10.0), 90-day mortality (OR = 10.8), and 90-day liver-related mortality (OR = 250) (all p < 0.0001).CONCLUSIONS: PHI defined as (Peak)Bil > 7.0 mg/dL accurately predicts liver-related death and worse outcomes after major hepatectomy. Standardized reporting of complications, PHI, and 90-day mortality is essential to accurately determine the risk of major hepatectomy and to compare outcomes data.